ADHD

Difficulty with attention, organization and follow-through is one of the most common complaints in adult psychiatry, and one of the hardest to attribute correctly. It may be ADHD; it may be depression, anxiety or poor sleep; often it is more than one. The evaluation is designed to tell them apart.

Who this is for

• Adults who suspect they have ADHD and have never been evaluated.
• People diagnosed in childhood who need thoughtful adult care.
• Attention difficulties occurring alongside depression, bipolar disorder or anxiety, where the right order of treatment matters.
• People for whom stimulant medication has not worked as expected, or has caused problems.
• Second opinions on a contested or uncertain diagnosis.

How I evaluate

ADHD is a developmental condition, so the evaluation reaches back to childhood — school records and the recollections of people who knew you then are welcome — and uses standardized rating scales alongside a detailed clinical history. It weighs the alternatives that can produce the same picture: a mood disorder, anxiety, insomnia or sleep apnea, substance use, and the effects of medication.

Treatment

• Medication. Stimulant and non-stimulant options, chosen with attention to co-occurring conditions and monitored properly.
• Treating what comes first. When ADHD coexists with a mood or anxiety disorder, the sequence of treatment matters; stabilizing mood is often the first step.
• Skills and structure. Psychotherapy and coaching approaches that address organization, time and follow-through, alongside or instead of medication.
• Sleep. Because untreated insomnia can look like — and worsen — ADHD, sleep is treated in parallel.